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Questions and Answers
What is the mechanism of action of Chlorpheniramine?
What is the mechanism of action of Chlorpheniramine?
Which adverse effect is associated with Promethazine?
Which adverse effect is associated with Promethazine?
What is the primary mechanism of action of Loratadine?
What is the primary mechanism of action of Loratadine?
Which of the following adverse effects is NOT associated with Pseudoephedrine?
Which of the following adverse effects is NOT associated with Pseudoephedrine?
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What mechanism characterizes the action of Oxymetazoline?
What mechanism characterizes the action of Oxymetazoline?
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Codeine primarily works by which mechanism?
Codeine primarily works by which mechanism?
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Which adverse effect is a known risk of using Chlorpheniramine?
Which adverse effect is a known risk of using Chlorpheniramine?
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Loratadine is best indicated for which of the following?
Loratadine is best indicated for which of the following?
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What is a key mechanism by which glucocorticoids reduce inflammation?
What is a key mechanism by which glucocorticoids reduce inflammation?
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Which of the following conditions is NOT commonly associated with glucocorticoid use?
Which of the following conditions is NOT commonly associated with glucocorticoid use?
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What is the recommended management to minimize osteoporosis risk in patients on long-term glucocorticoids?
What is the recommended management to minimize osteoporosis risk in patients on long-term glucocorticoids?
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Which parameter is important to monitor in patients on glucocorticoids to assess potential adverse effects?
Which parameter is important to monitor in patients on glucocorticoids to assess potential adverse effects?
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In cases of gastric ulcer risk due to glucocorticoids, what preventive measure is often recommended?
In cases of gastric ulcer risk due to glucocorticoids, what preventive measure is often recommended?
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Which of the following best describes a common adverse effect of glucocorticoids in elderly patients?
Which of the following best describes a common adverse effect of glucocorticoids in elderly patients?
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What is a potential consequence of chronic glucocorticoid use regarding growth in pediatric patients?
What is a potential consequence of chronic glucocorticoid use regarding growth in pediatric patients?
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What is one of the therapeutic goals when prescribing glucocorticoids to patients with respiratory issues?
What is one of the therapeutic goals when prescribing glucocorticoids to patients with respiratory issues?
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Which of the following populations is considered high risk when prescribing glucocorticoids?
Which of the following populations is considered high risk when prescribing glucocorticoids?
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What physiological change is associated with excessive glucocorticoid use?
What physiological change is associated with excessive glucocorticoid use?
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What is the main difference between first-generation and second-generation histamine I antihistamines?
What is the main difference between first-generation and second-generation histamine I antihistamines?
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Which of the following medications would you recommend for a patient with a history of anaphylaxis, experiencing mild allergic rhinitis symptoms?
Which of the following medications would you recommend for a patient with a history of anaphylaxis, experiencing mild allergic rhinitis symptoms?
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A patient presents with symptoms of seasonal allergies including runny nose, itchy eyes, and sneezing. He reports having a history of sleep problems. What would be a suitable recommendation?
A patient presents with symptoms of seasonal allergies including runny nose, itchy eyes, and sneezing. He reports having a history of sleep problems. What would be a suitable recommendation?
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A breastfeeding mother is presenting with symptoms of allergies. Which of the following medications would be a safe and effective treatment option?
A breastfeeding mother is presenting with symptoms of allergies. Which of the following medications would be a safe and effective treatment option?
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In addition to allergy treatment, some histamine I antihistamines are also indicated for which of the following conditions?
In addition to allergy treatment, some histamine I antihistamines are also indicated for which of the following conditions?
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What is one of the primary differences in the molecular mechanism of action between glucocorticoids and most other drugs?
What is one of the primary differences in the molecular mechanism of action between glucocorticoids and most other drugs?
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Which of the following is a common adverse effect associated with the use of glucocorticoids?
Which of the following is a common adverse effect associated with the use of glucocorticoids?
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In the acute management of anaphylaxis, what mechanism of action makes epinephrine particularly effective?
In the acute management of anaphylaxis, what mechanism of action makes epinephrine particularly effective?
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What is a key prescribing consideration for antihistamines when treating allergic rhinitis?
What is a key prescribing consideration for antihistamines when treating allergic rhinitis?
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Which factor is essential in determining the appropriate clinical intervention for a patient with allergy symptoms?
Which factor is essential in determining the appropriate clinical intervention for a patient with allergy symptoms?
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What adverse effect might be expected in a patient taking sympathomimetic medications?
What adverse effect might be expected in a patient taking sympathomimetic medications?
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Which characteristic is true regarding the physiology of natural immunity?
Which characteristic is true regarding the physiology of natural immunity?
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What is one of the physiologic effects of histamine-2 stimulation?
What is one of the physiologic effects of histamine-2 stimulation?
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For patient education regarding glucocorticoids, what is a crucial aspect to explain?
For patient education regarding glucocorticoids, what is a crucial aspect to explain?
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What is a primary consideration in the prescribing of medications to manage allergic rhinitis?
What is a primary consideration in the prescribing of medications to manage allergic rhinitis?
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What is a primary effect of glucocorticoids on metabolism?
What is a primary effect of glucocorticoids on metabolism?
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How do glucocorticoids primarily exert their effects at the molecular level?
How do glucocorticoids primarily exert their effects at the molecular level?
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What is a significant risk of long-term glucocorticoid use in children?
What is a significant risk of long-term glucocorticoid use in children?
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What specific risk does the use of glucocorticoids in pregnant women pose?
What specific risk does the use of glucocorticoids in pregnant women pose?
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Which physiological effect is NOT associated with glucocorticoids?
Which physiological effect is NOT associated with glucocorticoids?
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In the context of hypertension, what is an important effect of glucocorticoids?
In the context of hypertension, what is an important effect of glucocorticoids?
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What long-term effect can glucocorticoids have on bone health?
What long-term effect can glucocorticoids have on bone health?
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What is a potential impact of glucocorticoids on lung maturation?
What is a potential impact of glucocorticoids on lung maturation?
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During the stress response, which axis is primarily involved in glucocorticoid secretion?
During the stress response, which axis is primarily involved in glucocorticoid secretion?
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Which effect is primarily associated with glucocorticoids in the context of inflammation?
Which effect is primarily associated with glucocorticoids in the context of inflammation?
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What is the mechanism of action of Promethazine?
What is the mechanism of action of Promethazine?
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What is a major adverse effect of Promethazine?
What is a major adverse effect of Promethazine?
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What is the mechanism of action of Loratadine?
What is the mechanism of action of Loratadine?
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What drug is contraindicated in patients with Parkinson's disease?
What drug is contraindicated in patients with Parkinson's disease?
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What drug has an Alpha Adrenergic and Vasoconstriction mechanism of action?
What drug has an Alpha Adrenergic and Vasoconstriction mechanism of action?
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What is the mechanism of action of pseudoephedrine?
What is the mechanism of action of pseudoephedrine?
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What is the mechanism of action of codeine?
What is the mechanism of action of codeine?
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What is the first class of antibody produced in response to an antigen?
What is the first class of antibody produced in response to an antigen?
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Which type of antibody is produced in copious amounts in response to antigenic stimulation and is the major antibody in blood?
Which type of antibody is produced in copious amounts in response to antigenic stimulation and is the major antibody in blood?
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Which substance binds to the surface of mast cells and stimulates the release of histamine from them?
Which substance binds to the surface of mast cells and stimulates the release of histamine from them?
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Study Notes
Pharmacotherapy II: Immunology & Allergy
- Course offered by the Augsburg PA Program in 2025
- Instructor: Clinton Billhorn, PA-C, CAQ-HM
- Contact email: [email protected]
Learning Objectives
- Understand the physiology of natural, cell-mediated, and antibody-mediated immunity
- Recognize the effects of histamine-1 and histamine-2 stimulation
- Select appropriate medications for various patient scenarios across the lifespan, considering pharmacologic effects and patient-care concerns
- Summarize antihistamine prescribing considerations
- Review glucocorticoid synthesis, secretion, and effects
- Differentiate the mechanism of action between glucocorticoids and other drugs
- Provide patient education and a tapering schedule for glucocorticoid use
- Summarize glucocorticoid prescribing considerations
- Understand anaphylaxis pathophysiology and characteristics
- Outline acute anaphylaxis management in adults and children
- Explain how epinephrine works in anaphylaxis
- Apply pharmacologic management of allergic rhinitis for patients
- Describe adverse effects and administration of sympathomimetic medications
- Select appropriate medications for allergic rhinitis across the lifespan
- Provide common cold guidance for pediatric patients
Medications & Details
-
Chlorpheniramine (Aller-Chlor):
- Antihistamine (1st generation)
- MOA: Competitive histamine inhibitor
- Indications: Temporary allergy relief
- Adverse effects: Constipation, xerostomia, drowsiness
- Contraindications: Not for sleep aid
- Interactions: Avoid combination with other antihistamines
- Patient education: Avoid alcohol and driving
-
Promethazine (Phenergan):
- Antihistamine (1st generation)
- MOA: Competitive histamine inhibitor, blocks dopamine receptors, blocks alpha-adrenergics
- Indications: Rarely used for allergies
- Adverse effects: Arrhythmia, respiratory depression (children), neuroleptic malignant syndrome, akathisia, dystonia, elevated BP
- Contraindications: Parkinson's, myasthenia gravis
- Interactions: Avoid combination with other antihistamines and opioids
- Patient education: Very sedating, many side effects
-
Loratadine (Claritin):
- Antihistamine (2nd generation)
- MOA: Selective peripheral histamine antagonist
- Indications: Allergy symptoms, urticaria
- Adverse effects: Headache, xerostomia, dry eyes
- Contraindications: None, but QTc prolongation is a concern
- Interactions: Avoid combination with other antihistamines
- Patient education: Well-tolerated
-
Phenylephrine (Sudafed PE):
- Alpha adrenergic agonist
- MOA: Alpha agonist
- Indication: Nasal congestion
- Adverse effects: Hypertension, headache, blurred vision
- Contraindications: Heart disease, hypertension, Parkinson's
- Interactions: Avoid other sympathomimetics
- Patient education: Don't take if HTN, Parkinson's, don't take >3 days
-
Oxymetazoline (Afrin):
- Alpha adrenergic agonist
- MOA: Alpha adrenergic, vasoconstriction
- Indication: Nasal congestion, nosebleeds
- Adverse effects: Dry nose, rebound congestion
- Contraindications: No major contradictions
- Interactions: No major interactions
- Patient education: Do not use >3 days
-
Pseudoephedrine (Sudafed):
- Alpha-Beta agonist
- MOA: Stimulates alpha and beta receptors
- Indication: Nasal congestion
- Adverse effects: Tachycardia, HTN
- Contraindications: Heart disease, MAOI inhibitors
- Interactions: Alpha/Beta agonist
- Patient education: Do not use >3 days or if heart disease
-
Codeine:
- Opioid, antitussive
- MOA: Direct action in the medulla
- Indication: Cough
- Adverse effects: Respiratory depression, circulatory depression
- Contraindications: Airway compromise, OSA
- Interactions: Amphetamines, MAOIs, other CNS depressants
- Patient education: Respiratory depression requires discussion
Other Relevant Medications
- Diphenhydramine, Hydroxyzine, Epinephrine, Hydrocortisone, Prednisone, Methylprednisolone, Dexamethasone, Beclomethasone, Fluticasone propionate, Montelukast, Omalizumab, Dextromethorphan, Guaifenesin
Immunology
- Types of Immunity: Natural, Cell-Mediated, Antibody-Mediated
- Cell Types and Actions: B-cells, Cytotoxic T-cells, Helper T-cells, Macrophages, Mast cells, Basophils, Neutrophils, Eosinophils
Immunoglobulins
- IgA
- IgD
- IgE
- IgG
- IgM
Inflammation
- All pathways result in inflammation
Histamine
- Histamine I vs. Histamine II: Different effects (I: vasodilation, permeability, CNS effects; II: gastric acid secretion)
- Histamine I antihistamines (Cetirizine, Loratadine, Hydroxyzine, Diphenhydramine, Chlorpheniramine, Promethazine)
- Common drugs Histamine II (Famotidine, Cimetidine)
Cases
- Various clinical cases are presented covering different patient populations (infants, children, pregnant women, breastfeeding mothers, elderly, etc.) to evaluate appropriate treatment recommendations for allergic rhinitis, the common cold, and anaphylaxis
Glucocorticoids
- Synthesis, Secretion, and Effects
- Hypothalamic-Pituitary Axis (stress response)
- Mechanism of action - binding to receptors in the cytoplasm and direct impact on gene expression
- Patient Education (children, pregnant women, elderly)
- Key prescribing considerations & patient monitoring points
- Minimizing adverse effects (osteoporosis, hyperglycemia, ulcers, growth restriction)
Anaphylaxis
- Pathophysiology: Release of mediators, IgE/IgG mediated reactions, cytokines, eosinophils, chain reaction
- Characteristics: Skin/mucosa (90%), respiratory (85%), GI (45%), CV (45%)
- Acute Management (adults and children): Epinephrine, oxygen, normal saline, albuterol, H1/H2 antihistamines, glucocorticoids
- Mechanism of epinephrine: Alpha and Beta adrenergic receptor activity
Important Notes
- Specific dosages and recommendations for treatment provided for each case.
- The course emphasizes patient-centric care, including considerations for different age groups and health conditions.
- UpToDate articles are a relevant resource.
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Description
Test your understanding of immunology and allergy pharmacotherapy as taught in the Augsburg PA Program. This quiz will cover key concepts including immunity physiology, antihistamines, glucocorticoids, and anaphylaxis management. Prepare to apply your knowledge in various patient scenarios and medication selection.
